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ObjectId: 201441349349302154 - Submission: 2014-05-14
TIN: 43-1718408
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
MERCY HEALTH EAST COMMUNITIES
Employer identification number
43-1718408
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax idemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain
....
1b
Yes
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a?
.......
2
Yes
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
Compensation committee
Written employment contract
Independent compensation consultant
Compensation survey or study
Form 990 of other organizations
Approval by the board or compensation committee
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment?
................
4a
Yes
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization?
...........................
5a
No
b
Any related organization?
.........................
5b
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization?
...........................
6a
No
b
Any related organization?
.........................
6b
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III
............
7
Yes
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III
.............................
8
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012
Page 2
Schedule J (Form 990) 2012
Page
2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.
Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note.
The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A)
Name and Title
(B)
Breakdown of W-2 and/or 1099-MISC compensation
(C)
Retirement and other deferred compensation
(D)
Nontaxable
benefits
(E)
Total of columns
(B)(i)-(D)
(F)
Compensation
reported as deferred
in prior Form 990
(i)
Base compensation
(ii)
Bonus & incentive compensation
(iii)
Other reportable compensation
(1)
KAHN JOSEPH
BOARD MEMBER
(i)
(ii)
0
368,210
0
130,641
0
32,268
0
14,877
0
13,330
0
559,326
0
0
(2)
KEITHLY DENNIS
BOARD MEMBER
(i)
(ii)
0
262,310
0
0
0
19,272
0
64,014
0
10,510
0
356,106
0
0
(3)
WEICK MD RAY
BOARD MEMBER
(i)
(ii)
0
321,220
0
7,728
0
18,986
0
9,374
0
2,760
0
360,068
0
0
(4)
SORENSEN DONN
BOARD MEMBER & OFFICER
(i)
(ii)
0
521,255
0
246,031
0
99,865
0
91,947
0
11,714
0
970,812
0
0
(5)
JOHNSTON JEFFREY
OFFICER
(i)
(ii)
0
410,525
0
190,493
0
51,457
0
168,505
0
17,534
0
838,514
0
0
(6)
MATEJKA CHERYL L
CHIEF FINANCIAL OFFICER
(i)
(ii)
0
290,655
0
113,413
0
37,600
0
49,859
0
16,304
0
507,831
0
0
(7)
CANTALIN JEANNE L
REGIONAL VP-GENERAL COUNSEL
(i)
(ii)
0
195,767
0
71,459
0
21,448
0
27,145
0
9,730
0
325,549
0
0
(8)
HUBERT JOHN W
PRESIDENT, MERCY CLINIC
(i)
(ii)
68,386
518,787
0
159,131
1,547
50,514
0
80,070
1,142
10,545
71,075
819,047
0
0
(9)
KALICAK DONALD
VP - BUSINESS DEVELOPMENT & PLANNING
(i)
(ii)
198,521
0
98,708
0
44,793
0
78,335
0
11,847
0
432,204
0
0
0
(10)
MOORE ELAINE
CHIEF HUMAN RESOURCES OFFICER
(i)
(ii)
0
274,912
0
129,476
0
46,661
0
44,303
0
7,730
0
503,082
0
0
(11)
SCOFFIC DENISE
VP-FINANCE
(i)
(ii)
143,101
0
45,715
0
36,634
0
11,913
0
6,582
0
243,945
0
0
0
(12)
VARNER ANN
VP-MISSION
(i)
(ii)
0
132,079
0
37,141
0
25,117
0
10,537
0
7,844
0
212,718
0
0
(13)
REHM CHARLES H
CHIEF ADMIN OFFICER - EAST
(i)
(ii)
0
395,234
0
98,812
0
29,266
0
58,751
0
13,362
0
595,425
0
0
(14)
FRONCZAK THEODORE
VP-OPERATIONS
(i)
(ii)
161,713
0
45,544
0
21,216
0
9,771
0
12,982
0
251,226
0
0
0
(15)
ONESKO KIM M
SENIOR VP
(i)
(ii)
76,523
0
55,173
0
167,524
0
16,297
0
1,052
0
316,569
0
0
0
(16)
ROTHERMICH ANTHONY G
VP-OPERATIONS
(i)
(ii)
128,885
0
37,485
0
25,274
0
10,915
0
1,331
0
203,890
0
0
0
(17)
STIFFLER MARK R
VP-OPERATIONS
(i)
(ii)
150,129
0
41,906
0
18,207
0
3,141
0
6,143
0
219,526
0
0
0
(18)
VESPA JANICE M
VP-OPERATIONS
(i)
(ii)
161,464
0
46,264
0
21,048
0
17,392
0
11,665
0
257,833
0
0
0
(19)
COMBS RANDALL
FORMER OFFICER
(i)
(ii)
0
609,387
0
331,326
0
31,276
0
325,845
0
8,831
0
1,306,665
0
0
(20)
MCCURRY MICHAEL
FORMER OFFICER
(i)
(ii)
0
747,251
0
767,776
0
29,145
0
498,397
0
14,338
0
2,056,907
0
0
(21)
BEEKMAN SHERI D
FORMER KEY EMPLOYEE
(i)
(ii)
0
275,592
0
119,520
0
27,832
0
51,237
0
7,661
0
481,842
0
0
Schedule J (Form 990) 2012
Page 3
Schedule J (Form 990) 2012
Page
3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier
Return Reference
Explanation
PART I, LINE 1A
CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. TRAVEL FOR COMPANIONS IS PROVIDED IN RARE INSTANCES AND IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. WHERE COMPANION TRAVEL HAS RESULTED IN A TAXABLE EVENT, THE EMPLOYEES ARE TAXED FOR SUCH TRAVEL. SPOUSAL TRAVEL WAS PROVIDED FOR THE FOLLOWING EMPLOYEES OF RELATED ORGANIZATIONS: MICHAEL MCCURRY; JEANNE CANTALIN. LIMITED INSTANCES OF TAX GROSS-UPS MAY HAVE OCCURRED WITH RESPECT TO EXECUTIVES. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS ARE SUBJECT TO TAX TO THE EMPLOYEE. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE.
PART I, LINES 4A-B
KIM M ONESKO RECEIVED $124,229 OF SEVERANCE COMPENSATION FROM MERCY HEALTH EAST COMMUNITIES. PART I, LINE 4B: MERCY HEALTH, THE ULTIMATE PARENT COMPANY, OFFERS SUPPLEMENTAL RETIREMENT PLANS TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON RETIREMENT BASED ON COMPENSATION, AGE AT THE TIME OF BENEFIT COMMENCEMENT, LENGTH OF SERVICE WITH THE COMPANY AND/OR ITS AFFILIATES, AND LENGTH OF TENURE IN THE PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE FOLLOWING PLANS. THERE WERE NO PAYMENTS FOR THE FISCAL YEAR ENDED 6/30/2013. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) COMBS,RANDY; MCCURRY,MICHAEL; JOHNSTON,JEFFREY; SORENSEN,DONN SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN (SMRP) BEEKMAN,SHERI D; KALICAK,DON; MATEJKA,CHERYL L; REHM,CHARLES; CANTALIN,JEANNE; JOHNSTON,JEFFREY; SORENSEN,DON; HUBERT,JOHN; MOORE,ELAINE; KAHN MD,JOSEPH THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C).
PART I, LINE 7
THE RELATED ORGANIZATION WHICH EMPLOYS THOSE INDIVIDUALS LISTED ON PART VII, AND THE FILING ORGANIZATION WHEN APPLICABLE, PROVIDES A NON-FIXED BONUS PLAN FOR WHICH CERTAIN TIERS OF ITS EMPLOYEES ARE ELIGIBLE. FOR FISCAL YEAR 2013 (JULY 1, 2012 - JULY 30,2013) PAYMENT OF ALL OR PART OF THE BONUS WAS CONTINGENT UPON ATTAINMENT OF CERTAIN FINANCIAL TARGETS. PAYMENTS ARE MADE ANNUALLY IN OCTOBER FOLLOWING (I) THE CONCLUSION OF THE FISCAL YEAR AND (II) DETERMINATION OF GOAL ACHIEVEMENT. BONUS OPPORTUNITIES ARE TIERED PERCENTAGES AND ARE DEPENDENT UPON THE LEADERSHIP LEVEL AND ATTAINMENT PERCENTAGE. MERCY'S ATTAINMENT OF FINANCIAL GOALS ARE REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE OF MERCY HEALTH AND ARE THEN TAKEN INTO ACCOUNT WHEN ANALYZING EXECUTIVE COMPENSATION FOR REASONABLENESS.
SUPPLEMENTAL INFORMATION
PART III
PART I, LINE 3: MERCY HEALTH (PARENT COMPANY) IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THE FOLLOWING METHODS WERE USED BY MERCY HEALTH TO ESTABLISH COMPENSATION: -INDEPENDENT COMPENSATION CONSULTANT -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J (Form 990) 2012
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